Presbyopia

What is Presbyopia?

Presbyopia is a progressive eye condition that happens to everyone later in life. People with presbyopia have a hard time focusing up close. While hyperopia is commonly known as farsightedness and myopia as nearsightedness, presbyopia might be called “oldsightedness.” The term presbyopia is derived from Greek and Latin origins that mean “old eyes.”

Although presbyopia is usually seen in adults over the age of 40, the exact age of onset varies from person to person and depends on what type of eyeglass prescription (if any) the individual wore prior to its development. Many people with myopia (near-sightedness) can read comfortably without eyeglasses or contact lenses even after age 40. Presbyopia may seem to appear suddenly, but the actual loss of flexibility in the lens takes place over a period of years.

According to the American Optometric Association, presbyopia is not a disease and it cannot be prevented. There is no cure for presbyopia, but there many ways to improve near vision. Many new treatments are currently being researched (see below).

Presbyopia Signs and Symptoms

Signs of presbyopia include a need to hold magazines, books, or other reading material at arm’s length in order to focus. Symptoms of presbyopia may include:

  • Eye strain
  • Headaches
  • Blurred vision at normal reading distances
  • Eye fatigue or general fatigued feeling, especially at the end of the day
  • Squinting to focus on near objects
  • Decrease in ability to focus on near objects

What Causes Presbyopia?

Presbyopia is caused by the aging process. As we age, the lens of the eye becomes progressively more rigid and loses its ability to focus well. The exact cause of presbyopia is still debated. One theory is that the fibers in the lens stiffen and lose their ability to change shape easily. Another theory is that the lens grows too big to change shape. Trauma, occupation, and lifestyle may be factors as well.

Diagnosing Presbyopia

Presbyopia can be diagnosed with a series of eye exams and tests. Your eye doctor may examine your retina and check the integrity of your eye muscles. Although presbyopia is not related to the eye muscle functioning, the way the eye muscles function can determine the severity of the condition. Additional tests may include:

  • Visual acuity exam
  • Refraction test
  • Slit lamp exam

presbyopiapic

Presbyopia Treatments

People with presbyopia usually need treatment for both close-up vision and distance vision. Eyeglasses and contacts are common choices due to their affordability, availability, and convenience. A few surgical procedures are available, and several more are still undergoing trials. There are a number of different solutions to presbyopia, including:

  • Reading glasses
  • Multifocal eyeglasses
  • Monovision
  • Multifocal contact lenses
  • Laser vision correction - with either monovision or blended vision
  • Multifocal intraocular lens implants
  • Corneal inlays that increase depth of field – like the Acufocus lens
  • Combinations of options above

Prognosis for Presbyopia

The prognosis for presbyopia is good for most people. Some people will need to wear eyeglasses or contact lenses for the rest of their lives. Others may need to undergo more extensive treatments to correct their vision. Unfortunately there is no cure for presbyopia, and no way to prevent it.

Complications of Presbyopia

If left untreated, presbyopia will rob sufferers of the ability to read close up. Over time, activities such as driving, reading, or working may become difficult. Some people begin to have problems with depth perception. To avoid complications, seek treatment from your optometrist or ophthalmologist.

What’s New?

  • Several treatments are still undergoing trial in the US. Surgical Reversal of Presbyopia (SRP) is an example. This technique is currently under development by PresbyCorp. In this procedure, Scleral Expansion Bands (SEBs) are inserted into the sclera, causing the muscle fibers that focus the lens to tighten. SRP is still undergoing major trials because its risks include eye infections, erosion of SEBs, and decreased blood circulation in the eye, among others. Anterior ciliary sclerotomy (ACS) is a treatment in which several incisions are made in a radial pattern around the eye. This extra space supposedly allows the lens to change shape more easily. After some time, however, regression occurs, and the patient’s vision returns to how it was before the surgery. Another treatment being tested is the total replacement of the lens with an artificial one such as Crystalens or ReSTOR. The artificial lens is connected to the muscle fibers that were responsible for moving and focusing the original lens. The most currently promising treatment is corneal inlays that increase depth of field, like the Acufocus lens. With new treatments and advancements in technology, presbyopia sufferers should soon have many options.

Talking to Your Eye Doctor

  • I still have time before I turn 40; what can I do now to reduce my risk of developing presbyopia at a young age?
  • What are my treatment options?
  • Are you aware of any new treatment options that have recently come on the market?
  • Is your clinic doing any research into the prevention or treatment of presbyopia?
  • Which vitamins are good for my lens health?
  • Am I a candidate for monovision?

Did you know: Our focusing ability is at its maximum when we are about age 10?

References:
  • American Optometric Association, Presbyopia, http://www.aoa.org/x4697.xml
  • J. DiGirolamo, MD “The Big Book of Family Eye Care” (Basic Health Publications, Inc., 2011) 57-70
  • J. Anshel, MD “Smart Medicine for Your Eyes” (SquareOne Publishers, 2011) 296-298
This article was last updated on 09/2014